AB0832 Noninfectious uveitis from the rheumatologist’s perspective: patterns from a single Tertiary Referral Rheumatologic Clinic in Italy
Authors: P. Triggianese, M. Fatica, A. D’antonio, E. Cela, C. Minerba, G. Raffone, S. Modica, B. Kroegler, P. Conigliaro, E. Greco, A. Bergamini, M. S. Chimenti
Journal: Annals of the Rheumatic Diseases (2022)

Background The noninfectious uveitis (NIU) is the intraocular inflammation that can be the first or one of extra-articular manifestations of systemic inflammatory rheumatic diseases mainly including spondyloarthritis (SpA), Behcet’s disease (BD) and juvenile idiopathic arthritis (JIA) 1 . Rheumatologists are often asked to help in diagnostic assessment and relatively targeted treatment of particular subsets of NIU 2 . Objectives To explore patterns and treatments of NIU from a population-based single-center study carried out in a Tertiary Referral Rheumatologic Clinic. Methods Selection criteria of this cross-sectional descriptive study consisted of having a diagnosis of NIU in an age of onset ≥16 years old regardless of its etiology among patients who were admitted (February 2018-December 2021) to Rheumatologic Clinic of Tor Vergata University Hospital (Rome, Italy). Clinical data were collected from medical records: gender, age of onset and admission, recurrence and anatomic patterns, HLA-B27 susceptibility, associated rheumatologic diagnosis and treatments were investigated. Results We included 100 patients with 58% women. Median age at NIU onset was 39.6±15 years whereas patients were 44±14 years old at the first referral, without gender-difference. NIU represented the main reason of referral in 22% of cases. Anterior uveitis occurred in 73% of patients and posterior in 25%; intermediate (IU) and panuveitis (PanU) were isolated cases. The prevalent course was acute (57%) followed by recurrent (31%) and chronic (12%); both eyes were involved in 39 patients. Almost half of NIU was associated with SpA including IBD-SpA (20%), ankylosing spondylitis (AS, 18%), and Psoriatic Arthritis (12%). A diagnosis of BD was reported in 14% of NIU while Rheumatoid Arthritis and other systemic autoimmune diseases occurred in 11% and 12%, respectively. Idiopathic NIU and JIA-NIU constituted the lowest prevalence (8% and 5%, respectively). A higher prevalence of BD-NIU and AS-NIU resulted in males than females (p&lt;0.01 and p&lt;0.05, respectively). One-third of the NIU cohort (34.3%) showed B27 + : a higher percentage of unilateral (p=0.09) and acute course (p=0.02) occurred in B27 + than B27 - . AS was prevalent in B27 + NIU than B27 - (p&lt;0.00001) while IBD-SpA and BD were mainly present in B27 - NIU than B27 + (p=0.09 and p=0.04 respectively). The only two cases of IU and PanU were both idiopathic B27 - NIU. At the onset of NIU, most patients were not on systemic treatment (68%): remaining cases were on cDMARDs (22%) and bDMARDs (10%). During rheumatologic follow-up, 80% of patients changed therapies: cDMARDs were added in 43.7% patients while bDMARDs were started in 40%. Systemic steroids were added in the remaining 16.3% of patients. At the latest follow-up (follow-up-time 33±28 months), 86% of patients had achieved remission of NIU while 14% had recurrence of active uveitis. Conclusion Findings from this population-based study describe a representative estimate of extent and patterns of NIU in an Italian adult cohort from a single Rheumatologic Clinic and document that Rheumatologic referral might dramatically impact treatment strategies in NIU. References [1]Hysa, E., et al. (2021). Immunopathophysiology and clinical impact of uveitis in inflammatory rheumatic diseases: An update. European journal of clinical investigation, 51(8), e13572. doi.org/10.1111/eci.13572. [2]Rosenbaum, J. T., et al. (2019). New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Seminars in arthritis and rheumatism, 49(3), 438–445. doi: 10.1016/j.semarthrit.2019.06.004. Disclosure of Interests None declared